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Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization

Thomas M. Gill, MD; Mayur M. Desai, PhD; Evelyne A. Gahbauer, MD, MPH; Theodore R. Holford, PhD; and Christianna S. Williams, MPH
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From Yale University School of Medicine, New Haven, and Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.

Acknowledgments: The authors thank Susan E. Hardy, MD, and Mary E. Tinetti, MD, for review of an earlier draft of this manuscript; Denise Shepard, BSN, MBA, Bernice Hebert, RN, Shirley Hannan, RN, Martha Oravetz, RN, Alice Kossack, Barbara Foster, and Shari Lani for assistance with data collection; Wanda Carr and Geraldine Hawthorne for assistance with data entry and management; Peter Charpentier, MPH, for development of the participant tracking system; Joanne McGloin, MDiv, MBA, for leadership and advice as the project director; and the physicians and staff of the former CHC Physicians, who provided us with access to our study population.

Grant Support: In part by grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation and the National Institute on Aging (1R01AG17560-01A1). Dr. Gill is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar and the recipient of Academic Award K23AG00759 from the National Institute on Aging; during the course of this study, he was also a Paul Beeson Physician Faculty Scholar in Aging Research.

Requests for Single Reprints: Thomas M. Gill, MD, Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504.

Current Author Addresses: Dr. Gill: Yale University School of Medicine, Dorothy Adler Geriatric Assessment Center, 20 York Street, New Haven, CT 06504.

Dr. Desai: Veterans Affairs Connecticut Health Care Systems, 950 Campbell Avenue, West Haven, CT 06516.

Dr. Gahbauer and Ms. Williams: Yale Program on Aging, 1 Church Street, 7th Floor, New Haven, CT 06510-3330.

Dr. Holford: Yale University School of Medicine, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT 06510-3210.

Author Contributions: Conception and design: T.M. Gill, M.M. Desai, C.S. Williams.

Analysis and interpretation of the data: T.M. Gill, M.M. Desai, E.A. Gahbauer, T.R. Holford, C.S. Williams.

Drafting of the article: T.M. Gill, M.M. Desai, C.S. Williams.

Critical revision of the article for important intellectual content: T.M. Gill, M.M. Desai, E.A. Gahbauer, T.R. Holford, C.S. Williams.

Final approval of the article: T.M. Gill, M.M. Desai, E.A. Gahbauer, T.R. Holford, C.S. Williams.

Statistical expertise: M.M. Desai, T.R. Holford, C.S. Williams.

Obtaining of funding: T.M. Gill.

Administrative, technical, or logistic support: E.A. Gahbauer.

Collection and assembly of data: T.M. Gill.

Ann Intern Med. 2001;135(5):313-321. doi:10.7326/0003-4819-135-5-200109040-00007
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Restricted activity, defined as staying in bed for at least half a day or cutting down on one's usual activities because of an illness or injury (1), has high face validity as a measure of health and functional status, especially for older persons, who often value quality of life over longevity (2). The importance of restricted activity was recognized more than 20 years ago in the U.S. Surgeon General's original Healthy People Report (3), which identified reduction of restricted activity as one of its two major goals for older persons. Subsequently, several clinical trials of preventive interventions have included restricted activity as a key outcome measure (47).

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Assembly of Precipitating Events Project cohort.

The number of persons excluded for the reasons specified appears in parentheses. Participants were enrolled in a 4:2:1 ratio for low, intermediate, and high risk for disability to ensure that each group had a sufficient number of participants.

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Summary for Patients

Restricted Activity among Older People Living in the Community

The summary below is from the full report titled “Restricted Activity among Community-Living Older Persons: Incidence, Precipitants, and Health Care Utilization.” It is in the 4 September 2001 issue of Annals of Internal Medicine (volume 135, pages 313-321). The authors are TM Gill, MM Desai, EA Gahbauer, TR Holford, and CS Williams.


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